Prisoners in Kenya are at high risk of contracting HIV, and unless
the issue of unprotected sex is addressed, HIV transmission will
continue unchecked. According to a 2008 study, 8.6% of the 722 male
prisoners interviewed at 13 prisons admitted having sex in prison, 74.6%
of whom had had unprotected sex. Of the 59 inmates who had engaged in
sex while in prison, 21 reported having consented while two were raped.
Prisoners engaged in sex for food, money, cigarettes, or exemption from
certain duties. Numerous HIV-related services are offered to prisoners
including education, testing and provision of antiretroviral drugs, but
the government does not provide condoms because both homosexual sex and
sex in prison are against the law. HIV prevalence rates in prison are
10% compared to 7.4% nationally. (1)

In Rwanda, where an estimated 15% of male prisoners are
HIV-positive, health authorities have embarked on a campaign to teach
prisoners about HIV and encourage testing and treatment, but the new
strategy does not include condom provision, because sex in prison is
illegal. Reports recommend the removal of laws that criminalise and
discriminate against these groups and prevent condom provision. Aside
from sexual activity, inmates in prisons risk contracting HIV through
shared needles for intravenous drug use, razors and tattooing needles.
Overcrowding also puts prisoners at high risk of tuberculosis. (2)

Since 1989, the prison system of San Francisco, California, USA,
has provided condoms to male prisoners through individual counselling
sessions. Given the limitations of this approach, they decided to
install, stock and monitor a free condom-dispensing machine in a jail to
examine the feasibility of this way of providing condoms to prisoners.
After the machine was installed, prisoners' awareness of access to
condoms increased as well as their likelihood of having obtained
condoms. Particularly large increases in condom uptake were reported
among those in high-risk groups. Sexual activity did not increase,
custody operations were not impeded, and staff acceptance of condom
access for prisoners increased. (3)

(3.) Sylla M, Harawa N, Grinstead Resnick O. The first condom
machine in a US jail: the challenge of harm reduction in a law and order
environment. American Journal of Public Health 2010; 15 April. E-pub
ahead of print.